Editorial: Deaths with dignity

There are limits to what medicine can do for a terminally ill person with little time left. Anyone who has seen a loved one die of cancer or any number of ravaging diseases knows that. They can also witness the pain and turmoil of these deaths.

A question on the Nov. 6 ballot asks voters to weigh in on the Death With Dignity Act, which is Question 2. It would grant terminally ill people in Massachusetts the right to engineer the end of life, through a system with carefully constructed safeguards built on experience in other states.

Not surprisingly, this is an emotional subject about which many disagree. Both the state’s medical association and the Catholic Church are against it. While we respect these institutions, we think this question must be answered from the point of view of those who might avail themselves of this new law — the dying and their families.

People like Debra Hertz, a Northampton woman whose husband, preschool teacher Michael Southerland, died in May from the disease known as ALS. She looked on helplessly as his body deteriorated to the point where Southerland could only move his head.

There is no treatment for amyotrophic lateral sclerosis, also known as Lou Gherig’s disease. The neurodegenerative disorder ravages the body until muscle strength is so weak that the afflicted person needs a breathing machine and a feeding tube to stay alive.

Hertz, a Death With Dignity supporter who collected signatures at Southerland’s memorial service to get the measure on the ballot, said her husband was unsure if he would have taken the lethal dose, but he certainly wanted the choice. Southerland opted to forgo the breathing and feeding machines. He died a slow death. Death With Dignity isn’t the right choice for most people approaching the end of their lives or for most doctors, but it is an option people should have. It is an option Michael Southerland should have had.

Some fear this ballot question, if approved, would make it easier for people to get rid of aging or disabled loved ones. This worry is unfounded.

The Death With Dignity Act possess many safeguards to prevent someone from being coerced or making a rash decision about ending his or her life. Participation in Death With Dignity is optional for all doctors, pharmacists and other medical professionals. The medical profession is against the measure, and that fits its philosophical underpinning of doing no harm.

But again, we think it is vital to consider the people this law is designed to help. To qualify, a patient must find willing attending and consulting doctors to deliver a prognosis that the person has less than six months to live and is of sound mind.

In short, there is no longer a role in their lives for medical science beyond palliative care.

This law doesn’t prohibit great doctors from healing the sick. It confers mercy on those who have no hope of recovery and instead face weeks or months of degradation and suffering.

If there is any doubt as to the person’s mental state, he or she is referred to a psychologist for further evaluation and counseling. Witnesses have to be gathered, strict schedules have to be met and a pharmacist willing to dispense the drug must be found. Seeking to end one’s life through Death With Dignity is not a passive process susceptible to manipulation.

As seen in Oregon and Washington, states that legalized Death With Dignity years ago, few people take advantage of the law and there have been no reports of unscrupulous people using the legislation to hasten the death of a relative, according to the departments of health in both states.

In 14 years, a total of 935 Death With Dignity prescriptions have been written and 596 patients have died after ingesting the drugs employed. The people who have taken advantage of Death With Dignity in Oregon and Washington are typically 65 or older, well-educated and have cancer. Almost all of them were enrolled in hospice care when they applied for the drug — meaning these people were being medically cared for up until the end and aware of their options.

Some say Death With Dignity is a slippery slope, that if the state allows for the terminally ill to take their lives, others could be next. That is not the question on the ballot next week and such worries shouldn’t be allowed to obscure the facts here.

People laboring through an extended and painful death should not have to suffer because we as a culture are uncomfortable with death. This question carries a euphemistic name, but it really is about dignity in one’s final days. With heavy hearts, we support it. We believe it can alleviate awful moments for many that play out in private and, for that reason, can seem like someone else’s problem. It is everyone’s to confront.

Kate was an 85-year-old Oregonian who’d survived the bombing of Dresdin in 1945. Diagnosed with cancer, she’d begun to have some limitations, but not much pain. When she asked her doctor for assisted suicide, he was worried because her memory loss and other cognitive impairments indicated she might not meet the competency standard under Oregon’s Death with Dignity law.
Kate was referred to a psychiatrist, who noticed her mental deterioration, and the fact that her daughter Erika seemed to be advocating more vocally for assisted suicide than Kate. He wrote “She does not seem to be pushing for this” and did not have the “very high capacity required to weigh options about assisted suicide.” He refused to prescribe lethal drugs.
Kate’s daughter was angry. In an interview Erika described the safeguards as “roadblocks.” Kate went for a second opinion to a psychologist with her HMO. Though the psychologist also found memory problems and was concerned that Kate’s request for assisted suicide seemed to be influenced by her daughter’s wishes, he wrote the prescription.
To give her family respite from care-giving, Kate was sent to a nursing home for a week. After a week in a nursing home, she declared her desire to use the pills “now”, took the lethal drugs, and died.
Kate Cheney was unlucky in that the safeguards in the Oregon assisted suicide law failed her. Despite evaluations by her family doctor and a psychiatrist that she did not meet the competency requirement for assisted suicide, her family found a doctor who would write the prescription. And the law had no safeguards against Erika’s enthusiasm for her mother’s “choice,” placing Kate in a nursing home instead of arranging for respite care at home, or the possible financial incentives of an HMO recommending death over continued treatment.
With an elder abuse rate in Massachusetts of nearly 1 in 10, do we really want to pass a law that makes the ultimate elder abuse legal?